Single Case Agreement (SCA) Specialist bei None

POSITION SUMMARY:

The Single Case Agreement (SCA) Specialist manages and negotiates out-of-network single case agreements to support access and reimbursement for non-contracted patient care. This position ensures agreements are executed in a timely, accurate manner and in collaboration with internal and external stakeholders.

JOB SPECIFIC RESPONSIBILITIES:

•    Negotiate and secure SCAs with commercial, Medicaid, and out-of-state payors in a timely and accurate manner, ensuring agreements support both patient access and financial sustainability.

•    Collaborate with internal stakeholders—including CEOs, clinical leadership, Utilization Review, and Finance—to align service scope, reimbursement rates, and authorization requirements.

•    Serve as a point of contact with payors, maintaining proactive communication with case managers and contracting representatives to expedite agreements and resolve issues pre- and post-admission.

•    Document and maintain records of all agreements, negotiation activity, and outcomes to provide transparency, audit readiness, and leadership oversight.

•    Monitor agreement lifecycles to ensure continuous coverage, prevent funding gaps, and mitigate revenue risk.

•    Ensure credentialing and compliance requirements are met, guaranteeing SCAs are valid, enforceable, and consistent with payer standards.

•    Assist with claims-related issue resolution, including underpayment recovery and denial management, in partnership with Finance and Revenue Cycle teams.

•    Support departmental initiatives and perform additional responsibilities as assigned by the VP/Director of Network Management.

POSITION QUALIFICATIONS:

EDUCATION:

•    Bachelor’s degree in Healthcare Administration, Business, or related field preferred.

EXPERIENCE: 

•    2+ years of experience in healthcare contracting, payer relations, or revenue cycle operations.

•    Prior experience negotiating SCAs or managing out-of-network payor arrangements preferred.

SKILLS

•    Strong negotiation and problem-solving abilities.

•    Excellent communication and interpersonal skills for payer and internal collaboration.

•    High attention to detail and organizational skills.

•    Proficient in Microsoft Office, payer portals, and EMR systems.

LICENSURE/CERTIFICATION:

•    Non-required